RDXX Response to a catastrophe

 

(combination of multiple documents)

 

Components:

1.      Workplace

2.      Patient

3.      Anaesthetist

4.      Root cause analysis

 

1.Workplace response:

Replacement

·     Anaesthetist ceases clinical duties

·     Call in a relief anaesthetist

Isolation

·     Leave the scene untouched

·     Move the list to another operating theatre

Notifications

·     Hospital co-ordinator

·     Hospital insurers

·     ±Coroner

Documentation

·     Draft before final copy

·     Show to anaesthetist ± his/her MDO

·     Facts only

·     No opinions

·     No speculation regarding the cause

·     DO NOT ALTER THE ANAESTHETIC RECORD

 

2.Breaking bad news to the patient and relatives:

 

a.Preparation:

Plan

·     Arrange meeting without delay

·     Rehearse your lines

People

·     Patient/relatives ± support person

·     Anaesthetist ± support person

·     Proceduralist

·     Junior doctor (for documentation + learning)

Place

·     Private room

·     Chairs

·     All on the same level

 

b.Discussion:

Introduction

·     Introduce your team

·     Confirm identity of those attending

Assessment

·     Ask what they know already

·     Consider level of understanding

Tell

·     Fire a warning shot

·     Small pieces of information

·     Frequent pauses

·     Facts only

·     No jargon

·     Sympathy but not blame

Listen

·     Allow time to process

·     Acknowledge emotional response

·     Allow questions

Summarise

·     Say it again in 20 words

·     Offer further contact

·     Offer referral serves

 

3.Critical incident support to the anaesthetist

Risks

·     Dysfunctional behaviour

·     Adjustment disorder

·     PTSD

·     Early retirement

·     Substance abuse

·     Suicide

Supports

·     Family

·     Peers

·     Mentor

·     GP

·     Psychologist

·     Psychiatrist

·     Dedicated service: e.g. hospital EAP, ANZCA DSP, DHAS

Personal responsibility

·     Do not return to work until recovered

Department responsibility

·     Confidentiality

·     Provide trained support person (usually a psychologist)

·     No use having a judgemental culture

 

4.Root cause analysis

·        Formal review by hospital committee